Provider Demographics
NPI:1952409385
Name:MARTINEZ, RAFAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 N 15TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1134
Mailing Address - Country:US
Mailing Address - Phone:602-561-7062
Mailing Address - Fax:602-294-0408
Practice Address - Street 1:6726 N 15TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1134
Practice Address - Country:US
Practice Address - Phone:602-561-7062
Practice Address - Fax:602-294-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62010011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical